Clean teeth, renewed hope in Malawi

For ten years, UNC-Chapel Hill students have traveled to Malawi to provide free dental health care services, such as cleanings and fillings.

Malawi has a population of almost 16 million people, but there are fewer than 10 dentists throughout the country to meet their needs and many Malawians cannot afford to travel for dental care. Furthermore, one million people in Malawi are living with HIV, making prevention and proper healthcare a necessity.

UNC has strong ties to Malawi, where Carolina researchers began working more than 20 years ago. Since then, the relationship has deepened as faculty and students in various fields have helped tackle challenges such as HIV, malaria and a lack of basic health infrastructure.

The four students who participated in the 2013 Malawi Project through the UNC School of Dentistry Lillian Height, Jamal Garnett, Ashley Morgenstern and Benjamin Anders – shared their thoughts about their trip in July.

Ben Anders:
“My new friend, Dannie, a dental therapist in Malawi, taught me a new phrase, ‘Malawian mileage.’ As our patient, a young man named Fredrick, scooted into position in the dental chair, Dannie motioned to Fredrick’s feet. His sandals were caked in a dust that covered his feet and ankles like a layer of rust-colored paint.

‘Fredrick has walked over 16 kilometers (almost 10 miles) from his village to Lilongwe because he has a terrible toothache, and word has spread that American dentists are in town providing care. That’s a long way to walk for dental care—hence the visible ‘mileage’ on Fredrick’s feet,’ Dannie said.

We found extensive decay in one of Fredrick’s molars and, five minutes later, extracted the tooth without complication. As he left, Fredrick expressed his gratitude: ‘That was the most comfortable dental procedure I’ve ever experienced,’ Fredrick said to us in Chichewa. ‘Thank you for being so gentle!’

That’s what made me proud of what our team did in Malawi. We came to provide dental services and education in one of the world’s poorest countries. What we didn’t expect were the life-changing lessons we gained from the Malawian people: A renewed hope in humanity, a real-world education unlike any other and an appreciation for the privileged lives we lead as Americans.

My time in Malawi has changed who I am. The experiences I’ve shared with my classmates and the people I’ve met in the Warm Heart of Africa will undoubtedly make me a better clinician and a more understanding, caring citizen of the world.”

Lillian Height
“My most memorable moment involved a little girl, about 8 years old, who needed to have a baby tooth extracted. She was so frightened by the syringe containing the local anesthesic that she refused to open her mouth. She yelled and screamed at the top of her lungs but wouldn’t open her mouth for any of the dental therapists to anesthetize her. Her mother decided to let the girl decide who would give her the injection. Through her tears, she scanned the room slowly until she made eye contact with me and held my gaze. Finally, with no words, she simply held out her hand and pointed at me.

“Her mother held her arms and legs tight and I injected the little girl as painlessly as possible. She jumped a little at the initial pinch. Once I had the forceps, I grabbed a hold of the tooth. The little girl began to cry and scream wildly not because she could feel any pain but simply out of fear. In less than two seconds the tooth had been removed.

“The little girl sprang from her chair crying. I felt so bad that one of her first experiences at the dentist had to be so traumatic. As she was about to leave, she looked at me. I held my arms out to her. Moving slowly, she walked toward me and wrapped her arms around me. It was a small gesture but it meant the world to me. We couldn’t understand each other’s language, but it felt like we both understood the hug to be a truce. It was my apology for putting her through such a traumatic experience and her gratitude for taking away her pain.”

Jamal Garnett
“We worked the hardest in a rural village called Embangweni. Getting there takes a half-hour drive down a one-lane dirt road. Since the village is so far off the beaten path, it makes sense that many of the people have never seen a dentist. As word of our work spread, the number of people waiting to see us multiplied each day. We treated patients of all ages, from babies to the elderly. We met a 9-year-old boy named Blessing here. Children’s teeth typically come out easy, especially baby teeth. The hardest part is getting them to sit still long enough to inject the anesthesia. With children you never know how they will react to the shot. Some children take it really well, some quietly whimper and some scream and flail and need to be held down so the needle doesn’t hurt the child or us.

“With Blessing, I could see the apprehension on his face right away. As Blessing climbed into the chair, which was actually a bench press used for exercise, the look in his eyes showed he knew a needle was coming and that he wasn’t going to like it. I tried to hide the needle from him but as soon as he felt it inside his mouth he began to thrash uncontrollably. He was screaming so loud and he was moving so much that he actually broke the chair. It took the overseeing doctor, the man who was running our sterilization and Blessing’s mother to restrain him as well as a bite block to keep his mouth open so I could inject him with anesthesia. We finally got him numb and the tooth came out in less than 30 seconds, which is pretty quick. We saw Blessing the next day. He wasn’t in pain from the procedure or from the toothache. I enjoyed working with Blessing. His gratitude as well as all the other patients’ appreciation for our work made the long days worthwhile.”

Ashley Morgenstern
“People were already waiting for us each morning when we arrived at the clinic in Embangweni. One particular day, I noticed a woman lying on the ground as we started collecting health passports from everyone. There was a large facial swelling on her right side and she was clearly in some pain. Facial swellings often stem from an infected tooth and can be life threatening in some cases if they are not treated.

“The woman’s name was Thokozire and I soon learned that in addition to her pain, she had walked 30 minutes to get to the clinic that morning. Her toothache had persisted for about five days, but the swelling had started two days ago. The culprit for this acute infection was a pair of roots from one of her molars, which was broken down from decay. The roots were easily removed and Thokozire was given antibiotics to help with the remaining infection. Although routine, this procedure likely prevented her from developing more serious problems and may have conceivably saved her life.

“Patients like Thokozire as well as others who we treated made me stop and seriously consider the impact we made on people who otherwise may not have been able to see a dentist. It was a truly humbling experience that I will remember throughout my career.”

Dr. Jennifer Webster-Cyriaque, an associate professor in the department of dental ecology, is the faculty adviser for the program.

Read more about the UNC Malawi Dental Project.

Published September 20, 2013.